title: Emergency surgery for severe acute cholangitis. The high-risk patients.
abstract: Emergency surgery for patients with severe acute cholangitis carries formidable postoperative morbidity and mortality rates. A retrospective study was conducted on 86 consecutive patients who had exploration for the calculous obstructions to identify the high-risk population to guide better management. Septicemic shock was present in 55 patients before surgery. All patients had ductal exploration under general anesthesia. Additional procedures included cholecystectomy (n = 55), cholecystostomy (n = 5), and transhepatic intubation (n = 2). Complications and deaths occurred in 43 (50%) and 17 (20%) patients, respectively. Multivariate analysis on the 25 clinical (n = 14) and biochemical (n = 11) parameters evaluated yield the following five predictive factors (relative risk): the presence of concomitant medical problems (4.5); pH less than 7.4 (3.5); total bilirubin more than 90 mumol/l (3.1); platelet less than 150 x 10(9)/l (2.9), and serum albumin less than 30 g/L (2.9). In the presence of three or more albumin less than 30 g/L (2.9). In the presence of three or more risk factors, postoperative morbidity and mortality rates were 91% and 55%, respectively, which were significantly higher than those with two or less risk factors (34% and 6%, respectively). As thrombocytopenia developed even with transient hypotension, timely ductal decompression would improve outcome of these patients after surgery. For the high-risk population, application of nonoperative biliary drainage might be considered.
authors.affiliation: Department of Surgery, University of Hong Kong, Queen Mary Hospital, China.
authors.forename: E C
authors.initials: EC
authors.lastname: Lai
authors.forename: P C
authors.initials: PC
authors.lastname: Tam
authors.forename: I A
authors.initials: IA
authors.lastname: Paterson
authors.forename: M M
authors.initials: MM
authors.lastname: Ng
authors.forename: S T
authors.initials: ST
authors.lastname: Fan
authors.forename: T K
authors.initials: TK
authors.lastname: Choi
authors.forename: J
authors.initials: J
authors.lastname: Wong
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001663:Bilirubin / Q000097:blood; D002761:Cholangitis / Q000150:complications / Q000378:metabolism / Q000401:mortality / Q000601:surgery*; D004630:Emergencies; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism; D012772:Shock, Septic / Q000209:etiology
chemical_list: D012709:Serum Albumin; D001663:Bilirubin